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The Utility of Cervical Spine Bracing as a Postoperative Adjunct to Single-level Anterior Cervical Spine Surgery

BACKGROUND CONTEXT: Use of cervical bracing/collar subsequent to anterior cervical spine discectomy and fusion (ACDF) is variable. Outcomes data regarding bracing after ACDF are limited. PURPOSE: The purpose of the study is to study the impact of bracing on short-term outcomes related to safety, qua...

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Autores principales: Caplan, Ian, Sinha, Saurabh, Schuster, James, Piazza, Matthew, Glauser, Gregory, Osiemo, Benjamin, McClintock, Scott, Welch, William C., Sharma, Nikhil, Ozturk, Ali, Malhotra, Neil Rainer
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516037/
https://www.ncbi.nlm.nih.gov/pubmed/31143262
http://dx.doi.org/10.4103/ajns.AJNS_236_18
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author Caplan, Ian
Sinha, Saurabh
Schuster, James
Piazza, Matthew
Glauser, Gregory
Osiemo, Benjamin
McClintock, Scott
Welch, William C.
Sharma, Nikhil
Ozturk, Ali
Malhotra, Neil Rainer
author_facet Caplan, Ian
Sinha, Saurabh
Schuster, James
Piazza, Matthew
Glauser, Gregory
Osiemo, Benjamin
McClintock, Scott
Welch, William C.
Sharma, Nikhil
Ozturk, Ali
Malhotra, Neil Rainer
author_sort Caplan, Ian
collection PubMed
description BACKGROUND CONTEXT: Use of cervical bracing/collar subsequent to anterior cervical spine discectomy and fusion (ACDF) is variable. Outcomes data regarding bracing after ACDF are limited. PURPOSE: The purpose of the study is to study the impact of bracing on short-term outcomes related to safety, quality of care, and direct costs in single-level ACDF. STUDY DESIGN/SETTING: This retrospective cohort analysis of all consecutive patients (n = 578) undergoing single-level ACDF with or without bracing from 2013 to 2017 was undertaken. METHODS: Patient demographics and comorbidities were analyzed. Tests of independence (Chi-square, Fisher's exact, and Cochran–Mantel–Haenszel test), Mann–Whitney–Wilcoxon tests, and logistic regressions were used to assess differences in length of stay (LOS), discharge disposition (home, assisted rehabilitation facility-assisted rehabilitation facility, or skilled nursing facility), quality-adjusted life year (QALY), surgical site infection (SSI), direct cost, readmission within 30 days, and emergency room (ER) visits within 30 days. RESULTS: Among the study population, 511 were braced and 67 were not braced. There was no difference in graft type (P = 1.00) or comorbidities (P = 0.06–0.73) such as obesity (P = 0.504), smoking (0.103), chronic obstructive pulmonary disease hypertension (P = 0.543), coronary artery disease (P = 0.442), congestive heart failure (P = 0.207), and problem list number (P = 0.661). LOS was extended for the unbraced group (median 34.00 + 112.15 vs. 77.00 + 209.31 h, P < 0.001). There was no difference in readmission (P = 1.000), ER visits (P = 1.000), SSI (P = 1.000), QALY gain (P = 0.437), and direct costs (P = 0.732). CONCLUSIONS: Bracing following single-level cervical fixation does not alter short-term postoperative course or reduce the risk for early adverse outcomes in a significant manner. The absence of bracing is associated with increased LOS, but cost analyses show no difference in direct costs between the two treatment approaches. Further evaluation of long-term outcomes and fusion rates will be necessary before definitive recommendations regarding bracing utility following single-level ACDF.
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spelling pubmed-65160372019-05-29 The Utility of Cervical Spine Bracing as a Postoperative Adjunct to Single-level Anterior Cervical Spine Surgery Caplan, Ian Sinha, Saurabh Schuster, James Piazza, Matthew Glauser, Gregory Osiemo, Benjamin McClintock, Scott Welch, William C. Sharma, Nikhil Ozturk, Ali Malhotra, Neil Rainer Asian J Neurosurg Original Article BACKGROUND CONTEXT: Use of cervical bracing/collar subsequent to anterior cervical spine discectomy and fusion (ACDF) is variable. Outcomes data regarding bracing after ACDF are limited. PURPOSE: The purpose of the study is to study the impact of bracing on short-term outcomes related to safety, quality of care, and direct costs in single-level ACDF. STUDY DESIGN/SETTING: This retrospective cohort analysis of all consecutive patients (n = 578) undergoing single-level ACDF with or without bracing from 2013 to 2017 was undertaken. METHODS: Patient demographics and comorbidities were analyzed. Tests of independence (Chi-square, Fisher's exact, and Cochran–Mantel–Haenszel test), Mann–Whitney–Wilcoxon tests, and logistic regressions were used to assess differences in length of stay (LOS), discharge disposition (home, assisted rehabilitation facility-assisted rehabilitation facility, or skilled nursing facility), quality-adjusted life year (QALY), surgical site infection (SSI), direct cost, readmission within 30 days, and emergency room (ER) visits within 30 days. RESULTS: Among the study population, 511 were braced and 67 were not braced. There was no difference in graft type (P = 1.00) or comorbidities (P = 0.06–0.73) such as obesity (P = 0.504), smoking (0.103), chronic obstructive pulmonary disease hypertension (P = 0.543), coronary artery disease (P = 0.442), congestive heart failure (P = 0.207), and problem list number (P = 0.661). LOS was extended for the unbraced group (median 34.00 + 112.15 vs. 77.00 + 209.31 h, P < 0.001). There was no difference in readmission (P = 1.000), ER visits (P = 1.000), SSI (P = 1.000), QALY gain (P = 0.437), and direct costs (P = 0.732). CONCLUSIONS: Bracing following single-level cervical fixation does not alter short-term postoperative course or reduce the risk for early adverse outcomes in a significant manner. The absence of bracing is associated with increased LOS, but cost analyses show no difference in direct costs between the two treatment approaches. Further evaluation of long-term outcomes and fusion rates will be necessary before definitive recommendations regarding bracing utility following single-level ACDF. Medknow Publications & Media Pvt Ltd 2019 /pmc/articles/PMC6516037/ /pubmed/31143262 http://dx.doi.org/10.4103/ajns.AJNS_236_18 Text en Copyright: © 2019 Asian Journal of Neurosurgery http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Caplan, Ian
Sinha, Saurabh
Schuster, James
Piazza, Matthew
Glauser, Gregory
Osiemo, Benjamin
McClintock, Scott
Welch, William C.
Sharma, Nikhil
Ozturk, Ali
Malhotra, Neil Rainer
The Utility of Cervical Spine Bracing as a Postoperative Adjunct to Single-level Anterior Cervical Spine Surgery
title The Utility of Cervical Spine Bracing as a Postoperative Adjunct to Single-level Anterior Cervical Spine Surgery
title_full The Utility of Cervical Spine Bracing as a Postoperative Adjunct to Single-level Anterior Cervical Spine Surgery
title_fullStr The Utility of Cervical Spine Bracing as a Postoperative Adjunct to Single-level Anterior Cervical Spine Surgery
title_full_unstemmed The Utility of Cervical Spine Bracing as a Postoperative Adjunct to Single-level Anterior Cervical Spine Surgery
title_short The Utility of Cervical Spine Bracing as a Postoperative Adjunct to Single-level Anterior Cervical Spine Surgery
title_sort utility of cervical spine bracing as a postoperative adjunct to single-level anterior cervical spine surgery
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516037/
https://www.ncbi.nlm.nih.gov/pubmed/31143262
http://dx.doi.org/10.4103/ajns.AJNS_236_18
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